PT - JOURNAL ARTICLE AU - Enrico Fabris AU - Sinem Kilic AU - Dirk A A M Schellings AU - Jurrien M ten Berg AU - Mark W Kennedy AU - K Gerts van Houwelingen AU - Evangelos Giannitsis AU - Evelien Kolkman AU - Jan Paul Ottervanger AU - Christian Hamm AU - Arnoud W J van’t Hof TI - Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction AID - 10.1136/heartjnl-2017-311181 DP - 2017 Oct 01 TA - Heart PG - 1515--1520 VI - 103 IP - 19 4099 - http://heart.bmj.com/content/103/19/1515.short 4100 - http://heart.bmj.com/content/103/19/1515.full SO - Heart2017 Oct 01; 103 AB - Objective We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels.Methods A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18–96 hours thereafter (post PCI).Results There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post PCI. Patients with baseline NT-proBNP values above the median (137 pg/mL) had higher 30-day (5.1% vs 0.2%, p<0.001), 1-year (7.0% vs 0.7%, p<0.001) and 5-year (20.3% vs 4.9%, p<0.001) mortality as compared with patients with values below the median. Using multivariate Cox analysis, NT-proBNP above the median was an independent predictor for 5-year mortality (HR 2.73, 95% CI 1.47 to 5.06; p=0.002). Patients with values above the median who received early tirofiban treatment had significant lower mortality compared with patients treated with placebo at 30 days (2.7% vs 7.5%, p=0.021) and 1 year (4.5% vs 9.4%, p=0.043). At 5 years, a lower but non-significant mortality rate was maintained in the treatment group (18% vs 22.4%, p=0.265).Conclusions In patients with STEMI, baseline NT-proBNP level independently predicts long-term mortality. In patients with baseline NT-proBNP levels above the median, early prehospital treatment with tirofiban significantly reduced 30-day and 1-year mortality, suggesting that high-risk patients may derive particular benefit. This finding should be confirmed in other studies.Trial registration number ISRCTN06195297.